Conversation: Never say never - always hope - Larri Hayhurst, nurse educator

Sydney
14 July 2002

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Conversation: Never say never - always hope - Larri Hayhurst, nurse educator

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Conversation: Never say never - always hope - Larri Hayhurst, nurse educator

By Marilyn Kerjean

In Manila there is a little room in the San Lazaro Infectious Diseases Hospital where there are some small hand bowls for carrying water, some creams and mouthcare equipment.

It is the resource room for the hospital’s palliative care team, and while the equipment is rudimentary, the patients are extremely grateful.

So is Larri Hayhurst (pictured), the woman whose friends back in Sydney have supplied the goods with donations of “little bits of money”.

“When you have nothing, you are extremely grateful to those people that are doing a little bit,” she says.

“I see it as God’s people meeting huge need out of compassionate hearts.”

Larri Hayhurst, parishioner at St Andrew’s, Malabar, is an independent nurse educator and consultant.

Since last year she has worked on establishing and teaching an education program in palliative care in San Lazaro hospital, and training a team of educators who will carry the work forward.

The core group of about 10 doctors, nurses and volunteers are already beginning to teach others, and it looks as though the Starfish Palliative Care Education Program may be picked up as a model for introducing palliative care throughout the country.

On the team are Australian palliative care specialist Dr Sue Marsden, and a psychotherapist from New Zealand, Liese Groot-Alberts.

Both were part of the former Elizabeth Kubler-Ross Association, as was Larri.

“I’m an ordinary woman - I’m not even very young - but I’ve got an absolute passion for something that I’ve been catapulted into and I’ve been reeling from shock ever since,” Larri says.

She says the hospital, run by the Department of Health, is “indescribably run-down” in places and lacks proper resources.

The hospital staff are overburdened as well.

“Filipino carers carry huge amounts of work because they are not familiar with the concept of self-care,” says Larri.

“Nobody supports them, they become burnt out and they continue to work in a burnt-out state.”

Larri says there are sometimes only five nurses each shift to cover 100 patients.

There is a shortage of beds, sheets, pillows, towels, washers and soap. Even water.

“There’s often no water, no gloves, it puts the nurses at risk of all sorts of things,” Larri says.

It is in this environment that people die of AIDS, rabies and other illnesses, such as pneumonia.

Larri has committed to making four three-week visits to San Lazaro each year, as long as she can raise the funds to go.

The Sisters of Charity Foundation paid for her first five trips and her last visit in April was funded by Quaker Services of Australia.

This month Larri returns again, supported by Rotary.

It is a constant struggle for her to try to find funding to help her work, which she does voluntarily.

“I can’t say how desperate the program is for support,” she says. “The smallest amount goes a long way because all of it goes to the project.”

Her friends have made a difference through small-scale fundraising efforts. One sewed about 100 face washers for the hospital from old ripped-up towels.

Larri became aware of the dearth of resources for the dying in the Philippines through teaching palliative care for HIV/AIDS patients, as part of a World Health Organisation training project in the faculty of Medicine at the University of NSW in September 2000.

At the same time she taught coping with loss and grief to people supported to come here by the PASALAMAT* fund, a small private fund aimed at encouraging Australians and Filipinos to join in the fight against AIDS.

This led to her being invited by the president of the Positive Action Foundation Philippines to go to Manila to teach those two subjects there.

During her first visit, in January last year, Dr Benito Arca, the head of San Lazaro, offered Larri the role of developing and writing a long-term education program for palliative care across the hospital.

“I don’t think there is anywhere else in the world where palliative care is being introduced into an infectious disease hospital,” Larri says.

At the beginning, especially, some of the concepts Larri taught about caring for the terminally ill ran contrary to the hospital culture in which it was the norm to avoid talk about death. Nor was there any training on how to deal with people’s grief or anger.

Also, “Filipino people believe that if they break bad news they are responsible for the distress that comes of it,” says Larri.

“But it doesn’t help to pretend the person is not dying,” she says. This approach isolates the patient and can bring loneliness at the end of their lives.

Another shock Larri had on that first visit was the extent of the problem of rabies infections in Manila.

In San Lazaro, two people die of rabies every day.

With Dr Sue Marsden, Larri established a new medical and palliative care regime for the dying rabies patients that would keep them from becoming violent and fearful.

Larri also worked in the hospital to role model palliative care for the nurses.

On her last visit, in April, she nursed the last rabies patient to die in the locked room of the hospital that served as the isolation ward before the new system (including the use of anti-psychotic medicine) was in place.

“It was one of the most traumatic things I ever saw,” she said.

But the first patient to benefit from the new system, an 11-year-old boy, was completely different.

His last hours were “overwhelmingly sad”, but also “very special and beautiful”, says Larri, mainly because she had been able to keep him calm and comfortable, dispel his fear, and spend some time counselling the family as well.

Now the team at San Lazaro are working with the Philippine Department of Health to develop a strategy to introduce palliative care education throughout the department’s institutions in Manila, and possibly elsewhere in the nation of islands.

In this they also have the help of Dr Kathy Crintz, who studied at Newcastle University, and who runs a small palliative care unit in the Philippine General Hospital.

An internationally regarded palliative care specialist, Dr Eduardo Buerra, has now offered to analyse the data from the new rabies treatment regime at San Lazaro and use it to form a palliative care protocol for worldwide use.

Larri has worked in palliative care for 15 years and believes in it “passionately”.

“I have seen much suffering (and) I don’t see any integral value in suffering, but I see it as part of life,” she says.

“I believe the end of life is the most sacred time of life.

“It’s when people in their souls are preparing to meet their God. We don’t know what that is like, but when you are with (the dying), you can know something of that journey.

“And if palliative care is given expertly then it has the potential to allieviate suffering.

“There’s always hope, there is never a time when nothing more can be done. It is possible to keep people comfortable until they die.”

Larri is seeking donations or sponsorship for her ongoing input into the program. To help, call Jackie Perkins on (02) 9698 9103.